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You are here: Home / Articles / How to Manage, Treat Anemia of Inflammation in Patients with Rheumatic Disease

How to Manage, Treat Anemia of Inflammation in Patients with Rheumatic Disease

December 17, 2017 • By Ruth Jessen Hickman, MD

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Rheumatologists must consider anemia of inflammation, drug-induced anemia and other possibilities when evaluating their patients.

Rheumatologists must consider anemia of inflammation, drug-induced anemia and other possibilities when evaluating their patients.
Image Point Fr / shutterstock.com

Anemia is common in patients with systemic rheumatic disease, yet it may not get the attention it deserves. Anemia can result from chronic inflammation, treatment side effects or other disease factors, or it may signal an unrelated condition. Although diagnosis and treatment of anemia are sometimes challenging, clinicians must do their utmost to rigorously investigate the cause of anemia and treat where appropriate. With new drugs on the horizon to treat the anemia of inflammation, clinicians may soon have new treatment options to manage this condition.1

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Background

Many patients with systemic rheumatic disease have anemia of inflammation (sometimes called anemia of chronic disease) as a secondary result of their condition. However, many other kinds of anemia occur in rheumatic patients. If clinicians simply assume anemia is due to disease inflammation, they can miss other important medical conditions, such as chronic gastrointestinal bleeding and malignancy.1

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Anemia of inflammation seems to correlate with disease severity and disease activity. In studies of quality of life in patients with rheumatoid arthritis, resolution of anemia often correlates with resolution of symptoms and improved quality of life.2 Hemoglobin levels also correlate with the risk of certain comorbidities like cardiovascular disease.3 Yet it is something of an open question as to how much low-level anemia directly affects patients’ quality of life, disease morbidity and mortality. It may serve more as an indicator of overall disease status.

Guenter Weiss, MD, is professor of medicine and biochemistry and director of the Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology and Pneumology at the Medical University of Innsbruck, Austria. He says, “We have very limited information on the effect or persistence of anemia on the quality of life of such patients, as well as on the course of the underlying rheumatic disease.”

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Prevalence varies among different rheumatic diseases. Factors influencing prevalence rates include treatment status, nutritional intake, age, gender, gene polymorphisms and iron homeostasis. Rates of 10–66% have been cited in rheumatoid arthritis patients, with rates on the lower end of this scale in modern patients who have been aggressively treated.1,4

Causes of Anemia in Rheumatic Disease

Iron-deficiency anemia is the most common type worldwide, but anemia of inflammation is historically a more common cause of anemia in rheumatic patients with inflammatory disease.5 However, in certain groups of patients with well-controlled disease, anemia from iron deficiency may actually be more common. For example, a 2011 study of rheumatoid arthritis patients in the U.K. found more patients with iron-deficiency anemia than anemia from inflammation.4

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Filed Under: Conditions Tagged With: anemia, Cause, Clinical, Diagnosis, inflammation, kidney, macrocytic anemia, Management, outcome, pathophysiology, patient care, Rheumatic Disease, rheumatologist, rheumatology, systemic inflammatory syndrome, Test, Treatment, vitamin deficiencyIssue: December 2017

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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